FLYING

Dr Jules Eden, travel medicine specialist and founder of e-med, answers travellers' questions - as published in the following national publications

• The Guardian
• Independent On Sunday and/or
• Geographical Magazine

Q. I am currently recovering from varicose vein surgery on my left leg (I am 29). Several veins were removed from my leg and I have been advised to wear the prescribed compression stocking for a further week (the operation took place on Feb. 18th) I plan to fly to Paris at the beginning of April and would like to know a) if it will be safe to fly by then and b) if I should take any precautions e.g. wear a compression stocking during the flight.

A. No need to worry.Varicose veins are part of the superficial venous system and as such have no real role to play in the formation of the dreaded DVT’s. 6 weeks after the operation things should be back to normal with no residual inflammation or soreness in your lower legs.

The compression stockings are used post op to prevent swelling and aid blood return in your leg which now has less veins. This will be through the deeper leg veins.

So it’s OK to fly and for the short trip to Paris, it would be a shame to arrive in the fashion capital of the world in Spring, looking like you are dressed for Winter.

Q. My 14 year old son is in remission with Acute Lymphoblastic Leukaemia and has a Hickman line in situ for his maintenance treatment. We are going to Disneyland Paris in a few weeks (by air). Should we tell the airline and are there any possible problems? Thanks

A. There is no real need to tell them this. A Hickman line is an intravenous line place into one of the veins of the neck and goes down towards the heart. This is done so that shots of chemotherapy can be given regularly without needing to place a line in the vein each time.

It does not contain any air as after each dose it should be flushed through with normal saline/ heparin mix to stop it from clotting up. So there are no worries regarding air expansion on take off.

The only thing to watch for is on descent. When he has to equalize to pop his ears this can raise the pressure in the thorax and there may be a bit of flush back down the line. Make sure the cap on the line is tightly fitted to stop blood from oozing o

Q. I occasionally get really bad throbbing localised pain in my forehead as the plane starts its decent. It is often only one the one side of my forehead although sometimes I have had it on both sides. The strange thing is that it only happens on some flights. At other times I have no pain what so ever. Is this a sinus problem or is it an indicator of something more serious?

A. No need to worry, this is nothing more serious than a “sinal squeeze”. You have 3 sets of sinuses, and the biggest are in the forehead. These are called the frontal sinuses. When a plane descends, despite it being “pressurised” there is an increase in relative pressure, like when you dive underwater. So the air in the sinuses needs to be equalized by blowing more in up the nose. If you cant do this for whatever reason, then a small vacuum begins and begins to cause the sinal lining to swell up. Hence the pain.

If you are getting this regularly then it would be worth using a nasal decongestant about 2 hours before you land. Either a tablet called Sudafed, or a spray like Otrivine work well. If this fails then a trip to an ENT surgeon may be needed.

Q. I am writing to you beacuse I get very nervous when I fly. I have been on three flights in my whole life and everytime I fly I get this feeling of impending doom. Is there anything I can take to calm me down during the flight? Could there be a psychological disorder associated with fear of air travel? Please help.....

A. There is a psychological problem associated with flying, probably called aerophobia, however people suffer it in different ways.

It becomes a problem if it results in you not actually flying, but it seems you can get on the plane. A “feeling of doom” may be just mild symptoms so I think you can be easily cured.

Do not resort to drugs at this stage but look to go on one of those courses where you are put into a flight simulator with a psychologist. After 9/11 there has been a great demand for this treatment and there should be plenty of them in L.A.

They will look at what gives you these feelings and resolve them.

Q. I wonder if you could help with a problem regarding long haul travel. My husband is in remission from Non-Hodgkin's Lymphoma and has been clear for 5 years. The lesion was in the soft pallet in his mouth. He underwent aggressive chemotherapy and then radiotherapy to the mouth and nasal areas. The chemotherapy has resulted in peripheral nerve damage to both legs and feet and although it has improved, he has stabilised to numbness in the feet and lack of circulation to both legs.

The radiotherapy has damaged the facial sinus tissue and on short haul flights he always gets an infection in the sinus area. He is on steroid spray daily and regularly washes the nasal area and throat with saline solution in an effort to combat infection. We intend visiting Australia and New Zealand next year for a family wedding. Is there any significant risk as regards DVT and what can be done to reduce the risk of catching anything through the re-circulated air?

Would it help if we travelled on business class rather than economy or would that not make any difference? I would be grateful for any advice as this is a concern as to whether the trip may cause further damage and any risk of picking up a major infection. Many thanks in anticipation for any assistance.

A. If he has damage to the blood circulation of his legs then he has to pull out all the stops to avoid a DVT on the light.

So business class would be better, as there is more leg room and so less flexion at the knee, which classically slows the blood return and causes the clot.

He should use graded pressure stockings and take 150mg of aspirin.

Drink at least 4 –5 litres of water on the flight and take a regular hourly walk up the aisles.

Stopping infection will be hard. He needs to prevent the drying up of the nasal mucous. This acts as a barrier against in flight bugs. A mask as used against SARS can help.

If an infection does get hold though, have some amoxicillin handy to hit it hard and quick.

Q. I have a perforated eardrum and on descent experience excrutiating pain in my ear from increase in air pressure. I have tried using an earplug, sucking a sweet, swallowing repeatedly and yawning, all to no effect. The pain is so bad that I have started to dread flying. Is there anything I can do to prevent or alleviate the pain ?

A. This sounds a bit odd. If you have a hole in your eardrum, then as the plane descends air will contract in the middle ear, and air should be drawn into this space through the hole you have.

So either the hole has closed, or there may be a one way valve like situation stopping air from being sucked in.

You need to see your doctor again to check the current state of the eardrum. If the hole is still there then never ever use an earplug as this will worsen the situation.

Try using a tablet called Sudafed that dilates the Eustachian tube and allows air to pass more easily into the middle ear space.

Finally, if this really ruins flights, and there are no contraindications, then a grommet can be inserted. This is a plastic pipe put across the drum that allows air to vent easily in and out of the middle ear. This though needs an ENT referral, which can take some time.